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ON BEHALF 0 HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
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ACKNOWLEDGE TH I HAVE READ THIS APPLICATION. THAT THE INFORMATION
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I HEREBY
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GIVEN IS CORRECT. AND THA"LY LAWS REGULATING CONSTRUC-
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CITY OF EDMONDS NUMEIER
CONSTRUCTION PERMIT APPLICATION JOB SUITEJAPT,
ADDRESS
OwMX6�INESS LID NO.
7 PI -AT NAMEISUBDIVISION NO. LOT 10, UOIEE�
MAILING ADDRESS
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CT'o. ON TH E PUS -
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A.'N.""LL
GRADINGIFILL
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SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
YE P I A' DAY S
YE T I
PERMIT LIMIT� I AR - ROVIDED WORK S STARTED I H ,Ays A,
REVIEW FEES
IEW FEES
REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
G IN So EC".N FEE
END INSPECTION FEE
LI o G D oRS
PLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS� ASSIGNS AND SUCCESORS
FLIMITINANYWAY
;A IT - F
I N NTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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ANY AND
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LY
A LCLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
L
INSPECTION PEE
INSPECTION FEE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
D ME , MOB, Fy WA,�E ANY REOUIREMENTOF ANY CITY ORDINANCE
EEMED ToMODIFY.WAIVE OR REDUCE -
THE CITY'SABILITYTO ENFORCE ANYORDINANCE PROVISION.
NOR LIMIT 'NANYWAY THE ,
NOR
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
GIVEN I CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
S
LAWS R
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE EGULATINGCCNST�AYUEC�
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INSPECTR
IN VIOLATION OF THE "DoFt CODE OF THE STATE OF WASHINGTON RELATING
FOR
WoRKVENSCQMPENSA;p<jRt�PANCE AND RCW IA.27
(425)
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771-0220
0.30
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
1�8
VALUATION I FEE
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